Black women are 3 to 4 times more likely to suffer a pregnancy-related death than are white women. The maternal mortality ratio-the number of maternal deaths per 100,000 live births-in the U.S. is high compared to other countries. In New York City the maternal mortality ratio has been above the national average for 40 years and currently ranks among the highest in the US. Racial/ethnic disparities in New York City are more alarming as black women are 7 times more likely to die from pregnancy-related causes than white women. Potentially fatal complications of pregnancy include hemorrhage, hypertensive disorders of pregnancy, and cardiomyopathy and black women suffer greater mortality from all of them. Deaths associated with pregnancy in the United States are the tip of the iceberg; for every maternal death, 100 women experience severe maternal morbidity-potentially life-threatening diagnosis or receipt of a life-saving procedure. Severe maternal morbidity affects approximately 52,000 women annually in the US. Similar to racial/ethnic disparities in maternal mortality, black women are much more likely to suffer from severe maternal morbidity than white women. Since a significant proportion of maternal mortality and morbidity is considered preventable, quality of health care delivered in hospitals may represent a major lever for improving outcomes. We propose a mixed methods study to investigate the extent to which improving hospital quality could reduce racial/ethnic disparities in severe maternal morbidity. The objectives of this study are to: 1) Rank New York City hospitals by risk-adjusted severe maternal morbidity and examine disparities in the distribution of white, black, and Latino deliveries among these hospitals; 2) Use mixed methods to explore processes of care, unit characteristics, organizational factors, and patient factors associated with high and low rates of severe maternal morbidity hospitals; 3) Explore patients' perspectives on barriers to receipt of high quality care including their decision- making regarding delivery hospital, and perception of risk; and 4) Disseminate findings among key community and hospital stakeholders who have the power to promote uptake of the best practices and address the patient concerns. In the final phase of this project, we will bring leaders of obstetrics, NYC and State Department of Health officials, The Joint Commission, the American College of Obstetricians and Gynecologists, hospital quality leaders, community leaders, and mothers to discuss our results. We will explore interventions to improve care for women in NYC and narrow racial/ethnic maternal morbidity disparities and develop patient- centered strategies to reduce barriers to receipt of high quality care. This study aims to produce knowledge about organizational factors and processes of care that are of high relevance for the provision of quality inpatient maternity care; this information will be specifically tailored to units serving minority populations and applicable to other areas i the U.S. where racial/ethnic disparities exist between hospitals.